Addiction to prescription drugs and alcohol among older adults is rising in the U.S. but often goes undetected.
In 2023, an estimated 6.4 million Medicare beneficiaries had a substance-use disorder, according to federal data. At the same time, overdose rates among adults 65 and older increased by about 11% from 2022 to 2023, based on CDC estimates.
Prescription drug disorders are also a growing concern, with nearly 2 million Medicare beneficiaries diagnosed with opioid use disorder in recent years.
But alcohol remains the most common substance abuse problem, with more than 1 in 10 older adults reporting binge drinking, a rate that has increased significantly since the early 2000s, according to the National Institute on Alcohol Abuse and Alcoholism.
Experts say these problems are often overlooked, with fewer than 40% receiving appropriate treatment, in part because symptoms can resemble normal aging or dementia.
In advance of the International Day Against Drug Abuse and Illicit Trafficking on June 26, Michelle Shiota, director of the Substance Use and Addiction Translational Research Network and a professor in the Department of Psychology at Arizona State University, dives into the issue — explaining why it’s so often misdiagnosed and what can be done to address it.
Note: Answers have been edited for length and/or clarity.
Question: What are the most common triggers for substance misuse in older adults?
Answer: People often use alcohol and drugs to cope with distress, and although the belief that older adults are generally more unhappy than young and middle-aged adults is not accurate — midlife adults generally report the lowest levels of happiness — some specific issues are more prevalent among older adults.
Second, the responsibilities we have and other activities we enjoy often put a cap on substance use. For example, having an important work meeting, someone to take care of or a daytime activity you’re looking forward to the next day can be a good reason to make sure you don’t start the next day with a hangover. To the extent that older adults’ lives and activities are narrowing, this deterrent may be less pronounced.
Third, our bodies and brains change as we age in ways that alter how we respond to alcohol and other drugs. People begin to process alcohol less effectively starting much earlier in adulthood, so the same amount of beer, wine or whatever has a more potent effect and it takes longer to recover. Similar effects occur with a number of other addictive drugs. This may also increase risk of addiction if the person keeps drinking or using at the same rate as they did when younger.
But many of the causes of problematic use and addiction are the same across the lifespan. These include having another mental health concern such as anxiety, depression, PTSD or schizophrenia; having a genetic predisposition toward substance use disorders; current or prior experiences of trauma; and stressors that just make life harder, often called social determinants of health — economic stress, unstable housing, food insecurity — are all risk factors regardless of a person’s age.
Q: What role does chronic pain and long-term use of prescription medications play in substance misuse among older adults?
A: Chronic pain and opioid use for pain are risk factors for anyone, regardless of age. As we’ve seen in the opioid epidemic, opioid addiction commonly starts with people receiving prescriptions for opioid painkillers after an injury, surgery or other incident. As we age we are more likely to experience conditions that create pain and require pain management and opioids are still offered quite often as the first-line pain treatment. That is certainly a concern.
Q: Why is addiction in older adults so difficult to identify, and how is it often mistaken for conditions like dementia, depression or normal aging?
A: There is overlap in what substance use problems, depression and the early stages of dementia can look like, especially during short interactions such as visits with out-of-town family or primary care checkups. This is especially the case for problematic alcohol use. Declining social engagement, slow and/or unsteady physical movement, cognitive difficulties and negative mood can be associated with all three. When someone is showing this profile it is important to inquire about substance use and see if it could be a contributing factor.
Q: What warning signs should families and doctors look for that are often missed?
A: As noted above, changes in cognition, social engagement, activity and affect/emotion could all be related to a growing problem with alcohol or other drug use — and/or to a number of other issues related to aging.
At this point, it’s important to start a conversation about whether and how much the person is drinking or using other drugs. It’s not so much about addiction-specific signs that are unique to aging as it is about being able to start the conversation.
Have drinking and/or drug use increased over time? Are they causing problems in the person’s life and health, or interfering with their responsibilities and social activities? Is the person using drugs and/or alcohol to deal with boredom, loneliness or unhappiness? If they had previously been taking opioids for pain after injury or surgery, have they kept taking them beyond the recommended time?
Doctors should absolutely be screening for problematic substance use — it’s not yet required but is nonetheless really important‚ and families can keep lines of communication open about drug and alcohol use as well.
Q: If someone is worried about an older loved one, what is the first step they should take?
A: Talk to them. Ask what’s going on, and ask about their substance use. Listen lovingly and non-judgmentally to the answers. Get them help if needed.
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